of study issues.” He said that one study reported in the American Surgeon found a 12 percent decrease in overall trauma deaths within the BREMSS region after implementation of the system. Also, length of stay for those with Injury Severity Score (ISS) of 15 or greater dropped from 16 days to 11 days. Today, patients with an ISS of 15 or greater have dropped to 9 days.

He cited another study by a colleague at UAB who looked at trauma patients who were in the trauma system and who were transported directly to a Level I center. They looked at the same class of patients, those with ISS of 15 or greater, who went to a community hospital first and then were transferred to the Level 1 (UAB). They found that patients who went to the community hospital first had 50 percent greater mortality. Moreover, their cost of care within UAB was twice what the cost of care was for comparable patients taken directly to UAB.

Acker added that the area hospitals have actually reduced their divert processes. The number of hours of divert for emergency departments have decreased about 15 percent over the last four and a half years. He said they have not been able to solve their divert problem for psychiatric cases, which, he called, “a terrible problem.”

But, in general, we have the divert status in front of all of the hospitals all the time, Acker said, and “they literally will do everything they can do stay off of divert.” However, his own view is that patient care suffers when the hospitals exceed a certain capacity—whether it’s for a trauma, stroke, STEMI, or general medical patient. He said “I think to turn your head and say there’s no need for divert in a system is foolish, and the patient ultimately pays the price for that.”


Dawson, D. 2009. PowerPoint slide presented at the Regionalizing Emergency Care Workshop, Washington, DC.

Sasser, S. M., R. C. Hunt, E. E. Sullivent, M. M. Wald, J. Mitchko, G. J. Jurkovich, M. C. Henry, J. P. Salomone, S. C. Wang, R. L. Galli, A. Cooper, L. H. Brown, and R. W. Sattin. 2009. Guidelines for field triage of injured patients: Recommendations of the National Expert Panel on Field Triage. Morbidity and Mortality Weekly Report: Recommendations and Reports 58(RR01):1-35.

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